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Will this work?

This does not deal with the cultural problem which is that digital is not embedded in NHS thinking, and taking it and putting it in a separate box really doesn't help that. It will be the same people in a different box.

NHS Digital is rudderless and has not got its head around the fact that its sole purpose in life is to help clinical staff do a better job. There is zero customer awareness.

If I were doing this I would leave the existing structure and find a bunch of digital headkickers - people who have made things work and give them the resources to do more.

Clinical Safety Officer

This case is pretty embarrassing as Maureen Baker set up the programme for accrediting clinical safety officers who have to be clinically qualified.

As a clinical safety officer I have to review IT in structured way and assess the risk of it causing harm to patients.

As a clinical safety officer, there is no way I would sign off the 'Clinical Safety Case' if I did not have reasonable assurance that any software was compliant with the relevant legislation - in this case

Half-baked babble

This is going to go catastrophically wrong, and will be a magnet for ne'er do wells.

There are companies in this space who operate private clouds and that is fine - I even think it is fine to have cloud based back-up, and I could see a role for cloud-based dockers providing the front end, but hosting the data? I don't see this ending happily - there is a reason the banks are not on the cloud.

This is blue sky science

And none the worse for that.

The tension here is that government/ NHS will mess up the development of this but that pure industry - insurers and pharma - will use it to rip off the IP and the population, and the money goes overseas. Once the data has been copied, its value decays exponentially.

Pharma ought to be the best choice but the latest example of price gouging is holding the government to ransom over a cystic fibrosis drugs at £100k a year for marginal (non curative) benefit.

Better to commission an institution set up between uk academics and industry to manage the IP generated, and keep the data locked up tight.

Great analysis - thanks

So the question is - why have you got several thousand W7 desktops unpatched?

While I understand that the servers will need to be a variety of VMs I would just use a standard image of NHSbuntu [ www.nhsbuntu.org ] for the sheep as I can lock it down tighter than a duck's chuff, and it has secure email, an office suite, web-browsing and that is all I want them to have.

It is the apps tied to ActiveX that cause the problems

[I work in NHS IT]

Some of those places worst affected are just poorly managed but the reason why somewhere like Royal London (a new £1bn hospital) kept all these PCs with XP was that certain critical software could not be (cheaply) updated because it needed XP because the browser interface was written with a load of ActiveX that only worked in Internet Explorer 6 which is part of XP.

The root cause of these issues is therefore Microsoft's use of non-standard extentions as part of the embrace / extend / extinguish browswer wars.

there is a bigger problem

The medical heirarchy are wedded to a 1970s vision that all data must fit insided a RDMS model.

The dinosaurs have not yet worked out that while some structured data needs to be collected, the advances in indexing an mapping unstructured data in the last 15 years mean that they are using ancient technology to sove a problem that now does not exist.

self driving in Europe != success

I followed a Dutch registered Tesla model X on the outskirts of Cambridge last week that appeared to be in self-driving mode.

The reason I know this is because it spent most of the time with its outer two wheels way over the white line in the middle of the road, and this would never happen in a normal car - even LHD. The oncoming cars were understandably distressed by this behaviour.

I think self driving is fine if you are on a big ol' highway in Murica with plenty of room but in Europe it is going be much more challenging.

This is OK

[IAAD]

If I were a patient then I would be OK with this but I would not be OK with what Royal Free did which was to release the whole lot of identifiable patient information which is totally unacceptable. If Royal Free were a company then the Board would have to resign and there would be an eye-watering fine.

How about a rule that if there is a hospital data breach then the directors should pay the fine themselves AND have their medical data published on wikileaks?

This problem has been sorted in the past

but big pharma killed the process because it was so effective.

In Australia in the 90s they had the Pharmaceutical Benefits Scheme that priced all drugs of a certain type according to the cheapest price. If people wanted the more expensive branded version they had to pay the difference.

It worked a treat, to such an extent that big pharma killed it off as part of a big trade agreement.

other options

IAAD and this is a real problem. In the ED we quite often want to take pictures of wounds, particularly if there is bone sticking out, as we don't want to keep unwrapping them to let people have a look as it makes infection more likely.

The NHS rules are very clear that taking pictures yourself would be a major offence .

The other way to do this is to use the patient's own phone to take the picture, and very few patients don't have a phone with a camera these days.

There is a wider problem with consumer technology being touted as a medical device e.g. heart sensors etc without going through proper (ISO 13485) accreditation. This means that Billy No Mates can create an app for health use with no quality control in either software or hardware engineering. This is why Apple has just shut down a lot of its health programmes - the risk of harm (= swingeing lawsuits) is not worth it.

The NHS needs to get its act together and regulate on this or face a lot of pain when these apps are shown to be as effective as the Bomb Detectors the UK sold to Iraq. Reminds me of a quote from that great philosopher Benny Hill - 'just because no one complains, it doesn't mean all parachutes are perfect;,

Don't feed the troll

Your columns are excellent and are pitched just right for an audience that is interested in this and has a bit of experience.

Also appreciated by my daughter who is doing economics A level and applying to university to do economics.

My guess is that the push is to be more IT focussed rather than expand the magazine aspects of the weekend topics.

This is a mistake as the Register was building a powerful brand 'more than just IT' and as we know from Top Gear, this sort of branding that reaches across many demographics is very valuable, very difficult to build and very easy to destroy.